Leg Vein Minimization
Courtesy Cutera

Spider veins are superficial, wavy, thin, reddish-purple veins that occur over the legs, often clustered on the thighs or below the knees, that have become permanently dilated. Spider veins, or telangiectasias, affect as many as 80% of women and a large percentage of men. The cause is largely genetics and time, although pregnancy, childbirth, birth control pills, estrogen-replacement therapy, and previous injury can all be factors.

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How are spider veins treated?

The gold standard treatment is sclerotherapy, which involves injecting a solution into the vein to make it collapse, but this treatment is not always successful for very small veins. Excel V™ is a state-of-the-art system specially designed to treat facial veins and other vascular lesions, can be used to treat those spider veins unresponsive to sclerotherapy.

What is involved with laser treatment?

A laser produces a beam of highly concentrated single wavelength light. Different colors of light are absorbed by specific colors or pigments in the skin. When hemoglobin, found in red blood cells, absorbs yellow-green light, the heat generated seals the vein shut, and the now-diminished telangiectasias is reabsorbed by the body. A special Excel V™ Chilled Tip™ cools the skin during treatment, enhancing patient comfort.

What can you expect with laser therapy?

Most patients need between one and three ten-minute sessions per area spaced 4 weeks apart. The laser treatment itself feels like numerous small snaps with a rubber band. Immediate after-effects, if any, are minor. They may include redness, light crusting, tenderness, and, rarely, blistering. Dr. Binstock will be happy to tell you more about your treatment, its side effects, and what you can expect.

What can you tell me about Sclerotherapy for leg veins, especially the new Foam Technique?

The Foam Technique uses the newly FDA approved international gold standard agent, Aethoxyscelrol. When mixed in a syringe with air, aethoxysclerol turns into a foam which is more effective that solutions alone for treating blue reticular veins that are 1-4 millimeters in diameter.

Sclerotherapy is a technique which involves the use of a very fine needle to inject a solution or foam directly into the veins that injures the lining of the vessels, causing them to seal off and become less obvious.

Spider veins, or telangiectasias, of the legs are a common problem that particularly affects women. Small purple, blue, or red veins can form anywhere on the leg, from the top of the thigh to the ankle. These veins appear as lines resembling a sunburst or spider web pattern, or as short vessels.

Both telangiectasias and superficial varicose veins can be treated with sclerotherapy.

What will happen prior to treatment?

Prior to treatment, a complete medical history is taken and a thorough examination made in order to determine, among other things, how long the problem has existed, the severity of the symptoms, whether or not the condition is affected by physical activity, and if there has been prior surgery or treatment of the veins. Dr. Binstock determines if the deep venous system is affected, in which case surgery may be recommended before sclerotherapy is undertaken. Pretreatment instructions may include the elimination of certain drugs which contain aspirin in order to minimize the possibility of excess bleeding. The veins are usually marked while the patient is in a standing position.

How is sclerotherapy treatment (new Foam Technique) performed?

Larger veins are usually treated first. After the skin is thoroughly cleansed with alcohol, Dr. Binstock uses a syringe with a tiny needle to inject a small amount of foam sclerosing (irritating) solution directly into the vein. The foam solution displaces the blood within the vein, causing it to blanch, or turn white. The solution then causes the vessel to become irritated and swell shut, prohibiting the blood from reentering the vein. When the needle is withdrawn, pressure is immediately applied to the area. The skin may be massaged to help disperse the solution and reduce bruising. Each vein may require several injections and most disappear in two weeks to two months. Smaller veins are treated with a glycerin solution, hypertonic saline, or aethoxysclerol.

What should I expect following treatment?

Patients who have had sclerotherapy have reported little discomfort. Some experience a slight-to-moderate burning sensation immediately after the injection, but this disappears within a few seconds. Elastic stockings will be applied and should be worn for one week following the procedure.

You may resume normal activity immediately, although exercise is to be avoided for four days. Walking immediately after the procedure is encouraged to increases the blood flow through other veins. Elevation of the legs is not recommended unless large veins have been treated.

What are the side effects of sclerotherapy?

Most patients experience few if any adverse effects; however, some minor side effects have been reported. These include slight blistering, which can occur when small amounts of the solution seep into the surrounding areas or from the friction of the tape holding cotton balls in place over the vein.

Bruising around the treated area, which eventually disappears, can result if the veins are unusually weak. Bruising and skin discoloration tend to last longer in people of olive or dark complexion. Clots sometimes develop at the site of the injection. Although not a major cause for concern, it may be best to remove these clots within two weeks in order to facilitate the healing process.

A small percentage of patients develop a network of tiny pink vessels that turn white when pressure is applied. This condition, referred to as matte telangiectasia, usually disappears without treatment; however, injection treatment may be necessary in some cases. Rarely, there may be severe allergic reactions to these solutions; these reactions are treated immediately with antihistamines and other medications. Ulceration and scarring have also been reported.

Sometimes, spider veins recur and new spider and varicose veins can develope over time.

Most patients experience from 60–80% improvement, although final results may not be apparent for several months.

Will insurance pay for sclerotherapy treatment?

Insurance companies do not pay for sclerotherapy therapy as it is a cosmetic procedure.